The Meaning of Addiction
Preface to 1998 Edition
I have been gratified to see The Meaning of Addiction become the classic expression of the extensive research that shows addiction cannot be resolved biologically—lived human experience and its interpretation are central to the incidence, course, treatment, and remission of addiction. The data presented in this book indicate this is permanently the case. The idea, on the other hand, that new genetic and neurochemical discoveries will eliminate this irrefutable truth is the greatest of all myths about addiction.
The compulsion to bypass human experience in creating models of addiction is stronger than ever. The director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Enoch Gordis (1990: 1), believes that biological and genetic sources of alcoholism will be discovered and medical cures developed so that we can cease what he finds to be the pointless effort of understanding why people drink and why they drink too much:
For treatment to be most effective, a strong, long-term commitment is required to conducting research on the causes and consequences of disease. For example, sanitoria were widely available for the treatment of tuberculosis in the early 20th Century and provided the best treatment known at the time for this disease. However, it was not until medical scientists identified the tubercle bacillus and discovered useful antibacterial agents that the treatment for tuberculosis became effective.
Thus the head of the NIAAA misunderstands the fundamental nature of the problem he has been addressing in that capacity for over a decade. Gordis believes we will cure alcoholism the way we did tuberculosis. As this books shows, he is demonstrably wrong.
The leading U.S. government official charged with understanding addiction is the director of the National Institute of Mental Health, Steven Hyman, who was formerly the director of the Harvard Medical School Division of Addictions. Hyman (1996), writing in the prestigious journal Science, described how researchers are "shaking out the cause of addiction" in terms of specific brain mechanisms. Actually, Hyman discusses research that describes how opiates and other drugs act on the brain. But, as this book describes, most opiate users are not addicts, and most addicts give up or reduce their use of opiates as dictated by their life needs. The effects of drugs on the brain are a small variable contributor to addiction that are always mediated by social and personal interpretation.
The best indicator of the highly situationalized nature of addiction is the research overwhelmingly demonstrating that addicts in Vietnam, even when they used narcotics stateside, did not return to addiction. Lee Robins, John Helzer, and their colleagues (1980) described the research on the Vietnam veteran heroin experience that indicates treatment isn't necessary for recovery from heroin addiction (in fact veterans rarely required it), that reuse of narcotics by former addicts only occasionally and temporarily led to readdiction, and so on.
These prominent American scientists, who have conducted addiction research for decades, indicated that all of their previous notions of heroin—exactly the ones to which Hyman and others are currently addicted—were simply and fundamentally wrong. However, a few years later Helzer, Robins, and their colleagues (1985) wrote an article in the New England Journal of Medicine which concluded that alcoholics cannot resume moderate drinking (even though earlier they had found that the "highly addictive" drug heroin does not have such invariably addicting effects). The Meaning of Addiction ties together this myth of alcoholism with the other myths of addiction.
Ultimately, this book presents a systematic, seamless model of addiction that makes sense of the natural history for individuals, cultural variations in addictive experience, and the wide range of addictive experiences for different individuals with different involvements at different times and different places. This is the meaning of addiction—something that cannot bypass real people in real settings in in all their experiential and cultural richness. The effort to do otherwise is is strange and misguided, scientifically and therapeutically, and will eventually die away—but meanwhile doing horrible mischief.
Morristown, New Jersey
Gordis, E. 1990. Confronting alcohol abuse and dependence: Treatment research fortifies front lines. ADAMHA News Supplement (January/February):1-2.
Helzer, J.E.,; Robins, L.N.; Taylor, J.R.; Carey, K.; Miller, R.H.; Combs-Orme, T.; and Farmer, A. 1985. The extent of long-term moderate drinking among alcoholics discharged from medical and psychiatric treatment facilities. New England Journal of Medicine 312:1678-1682.
Hyman, S.E. 1996. Shaking out the cause of addiction. Science 273:611-612.
Robins, L.N.; Helzer, J.E.; Hesselbrock, M.; and Wish, E. 1980. Vietnam veterans three years after Vietnam: How our study changed our view of heroin. In The yearbook of substance use and abuse, eds. L. Brill and C. Winick, vol.2:213-230. New York: Human Sciences Press.